Secondary Sclerosing Cholangitis and Hodgkin's Lymphoma

Abstract

CONTEXTLiver damage is relatively common in patients affected by HL, but paraneoplastic cholestasis is an uncommon presenting symptom in HL.CASE REPORTWe report the case of a 38-year-old man who came to our hospital with jaundice, pruritis, nausea, vomiting, weight loss, and recurrent episodes of fever without any hepatosplenomegaly or lymphadenopathy. Laboratory findings showed abnormal liver functioning with mixed hepatocellular and cholestatic patterns. Sonographic evaluation of the biliary tract was normal. We ruled out viral infections, autoimmune process, and hemochromatosis. The patient was put on ursobile and NAC (N-acetyl-systeine) and prednisolone treatment. In magnetic resonance cholangiopancreatography examination, there were multiple strictures in the intrahepatic and extrahepatic bile ducts with mild dilatation. Histologic finding of liver biopsy was compatible with sclerosing cholangitis or drug-induced cholestasis. General condition and laboratory examination results of the patient became better, but we found lymph-adenopathy on monthly follow-up examination. Histological finding of the lymph node was compatible with HL.CONCLUSIONThis report emphasizes that HL can be presented with different paraneoplastic symptoms and that one of them is secondary sclerosing cholangitis. It has better prognosis than vanishing bile duct syndrome, and perhaps steroid treatment can be suggested.

Paraneoplastic Syndromes in Children with Hodgkin Lymphoma

“…[5][6][7] In addition to the above, hepatic, dermatologic, and rheumatologic manifestations have also been described in adults. 3,6,[8][9][10][11] PNS in children with HL is relatively rare, with few published case reports and case series in this population. This article will review the state of knowledge of PNS in pediatric HL.…”